Treatment Documentation in Practice-Based Evidence Research for Patients Receiving Physical Therapy Due to Lymphedema

Dorit Tidhar, MScPT, Daniel Deutscher, PT, PhD, Susan D. Horn, PhD, Jane M. Armer, RN, PhD, CLT, FAAN. Archives Of Physical Medicine And Rehabilitation, 2019/em>

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Treatment Documentation in Practice-Based Evidence Research for Patients Receiving Physical Therapy Due to Lymphedema

Dorit Tidhar, MScPT, Daniel Deutscher, PT, PhD, Susan D. Horn, PhD, Jane M. Armer, RN, PhD, CLT, FAAN. Archives Of Physical Medicine And Rehabilitation, 2019

Objectives

To describe the development and testing of a physical therapy treatment code documentation taxonomy.

Design

Clinician survey within a practice-based evidence study framework for patients with lymphedema. 

Setting

Outpatient physical therapy clinics within a large public health care service using a central electronic medical record. 

Participants

Certified lymphedema therapists (CLTs) (N=43).

Intervention

Treatment coding of 10 treatment vignettes representing real-life clinical scenarios. The CLTs were asked to accurately select 35 activity-intervention combination codes.

Main Outcome Measures

The CLT score represented percentage of treatment codes accurately selected by each therapist. The code score represented percentage of CLTs who accurately selected each treatment code.

Results

The mean CLT score was 91%, with 72% of CLTs meeting the 90% criterion. Personal feedback was provided to each CLT. The mean code score was also 91%; with 71% of treatment codes meeting the 90% criterion. We identified 9 low-score codes needing additional education or found to be redundant. These codes were either clarified or removed.

Conclusions

The proposed treatment code documentation system for lymphedema therapy was found to be clear and accurately used by most CLTs. Specific needs for improvement were identified. Follow-up testing is warranted to ensure ongoing accurate implementation of the treatment documentation system.

Main findings

  • An accuracy test of treatment code documentation was conducted to evaluate the ability of the certified lymphoedema therapists (CLTs ) to accurately select treatment codes using 10 treatment vignettes describing real-life treatment scenarios.
  • Twenty-six (96%) lymphedema therapists participated in the accuracy test. The mean CLT score was 77% and the mean code score was 79%.
  • Final code list consisted of 39 codes.
  • Forty CLTs from MHS and 33 CLTs from the private sector who provide services to MHS received an email including a link to a computerized survey. They were asked to accurately select 35 activity-intervention combination codes based on 10 treatment vignettes describing real-life treatment scenarios.
  • Sixteen CLTs (of 43) accurately selected fewer than the a priori quality threshold of 90% of activities or activity-intervention combination codes. Of these 16, a total of 14 accurately selected more than 90% of the activity codes and 10 accurately selected more than 90% of the intervention codes.
  • The new lymphedema treatment code taxonomy encompasses the codes that CLTs deemed relevant during routine care. An accuracy test revealed overall high scores on the CLT and code levels; however, we identified mistakes on the level of the CLT related to mismatching the right activity code with an intervention code. On the code level, we identified redundant codes and codes used incorrectly; modifications were made accordingly. A follow-up examination is needed to ascertain if findings from the accuracy test were implemented successfully. The new proposed lymphedema treatment code system offers an accurate and comprehensive taxonomy capturing the most important treatment processes. These may be studied for their associations with patient-centered outcomes within a practice based evidence (PBE) framework, an essential practice for the benefit of all patients. Other lymphedema treatment services may benefit from conducting a PBE process to improve accuracy and reliability of treatment documentation.